Higher risk of 2-year cup revision of ceramic-on-ceramic versus ceramic-on-polyethylene bearing: analysis of 33,454 primary press-fit total hip arthroplasties registered in the Dutch Arthroplasty Register (LROI)

Background and purpose: The influence of bearing on short-term revision in press-fit total hip arthroplasty (THA) remains under-reported. The aim of this study was to describe 2-year cup revision rates of ceramic-on-ceramic (CoC) and ceramic-on-polyethylene (CoPE). Patients and methods: Primary press-fit THAs with one of the three most used cups available with both CoC or CoPE bearing recorded in the Dutch Arthroplasty Register (LROI) were included (2007–2019). Primary outcome was 2-year cup revision for all reasons. Secondary outcomes were: reasons for revision, incidence of different revision procedures and use of both bearings over time. Results: 2-year Kaplan-Meier cup revision rate in 33,454 THAs (12,535 CoC; 20,919 CoPE) showed a higher rate in CoC (0.67% [95% CI, 0.54–0.81]) compared to CoPE (0.44% [95% CI, 0.34–0.54]) ( p = 0.004). Correction for confounders (age, gender, cup type, head size) resulted in a hazard ratio (HR) of 0.64 [95%CI, 0.48–0.87] ( p = 0.019). Reasons for cup revision differed only by more cup revision due to loosening in CoC (26.2% vs.1 3.2%) ( p = 0.030). For aseptic loosening a revision rate of 0.153% [95% CI, 0.075–0.231] was seen in CoC and 0.058% [95%CI 0.019–0.097] in CoPE ( p = 0.007). Correction for head size resulted in a HR of 0.475 [95% CI, 0.197–1.141] ( p = 0.096). Incidence of different revision procedures did not differ between bearings. Over time the use of CoPE has increased and CoC decreased. Conclusions: A higher 2-year cup revision rate in press-fit THA was observed in CoC compared to CoPE. Cup loosening was the only significantly different reason for revision and seen more often in CoC and mostly aseptic. Future randomised controlled trials need to confirm causality, since the early cup revision data provided has the potential to be useful when choosing the bearing in press-fit THA, when combined with other factors like bone quality and patient and implant characteristics.

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Comparable mortality but higher revision rate after uncemented compared with cemented total hip arthroplasties in patients 80 years and older: report of 43,053 cases of the Dutch Arthroplasty Register

Acta Orthopaedica ◽

10.2340/17453674.2021.886 ◽

2021 ◽

Author(s):

Esther M Bloemheuvel ◽

Liza N Van Steenbergen ◽

Bart A Swierstra

Keyword(s):

Regression Analysis ◽

Cox Regression ◽

Revision Rate ◽

Fixation Method ◽

Arthroplasty Register ◽

Cox Regression Analysis ◽

Total Hip ◽

Kaplan Meier ◽

Prosthesis Revision ◽

Hip Arthroplasties

Background and purpose — Mortality and revision risks are important issues during shared decision-making for total hip arthroplasty (THA) especially in elderly patients. We examined mortality and revision rates as well as associated patient and prosthesis factors in primary THA for osteoarthritis (OA) in patients ≥ 80 years in the Netherlands. Patients and methods — We included all primary THAs for OA in patients ≥ 80 years in the period 2007–2019. Patient mortality and prosthesis revision rates were calculated using Kaplan-Meier survival analyses. Risk factors for patient mortality and prosthesis revision were analyzed using multivariable Cox regression analysis adjusted for age, sex, ASA class, fixation method, head size, and approach.Results — Mortality was 0.2% at 7 days, 0.4% at 30 days, 2.7% at 1 year, and 20% at 5 years. Mortality was higher in males and higher ASA class, but did not differ between fixation methods. The 1-year revision rate was 1.6% (95% CI 1.5–1.7) and 2.6% (CI 2.5–2.7) after 5 years. Multivariable Cox regression analysis showed a higher risk of revision for uncemented (hazard ratio [HR] 1.6; CI 1.4–1.8) and reverse hybrid THAs (HR 2.9; CI 2.1–3.8) compared with cemented THAs. Periprosthetic fracture was the most frequently registeredreason for revision in uncemented THAs. Interpretation — Mortality is comparable but revision rate is higher after uncemented compared with cemented THA in patients 80 years and older, indicating that cemented THA might be a safer option in this patient group.

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Letter to the editor regarding “Ceramic-on-ceramic articulation in press-fit total hip arthroplasty as a potential reason for early failure, what about the survivors: a ten year follow-up” by Loon et al.

International Orthopaedics ◽

10.1007/s00264-021-04996-5 ◽

2021 ◽

Author(s):

Weifeng Ji ◽

Jing Shen

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Early Failure ◽

Total Hip ◽

Press Fit ◽

Potential Reason ◽

Letter To The Editor ◽

Ceramic On Ceramic

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Organisation, data evaluation, interpretation and effect of arthroplasty register data on the outcome in terms of revision rate in total hip arthroplasty

International Orthopaedics ◽

10.1007/s00264-010-1131-4 ◽

2010 ◽

Vol 35 (2) ◽

pp. 157-163 ◽

Cited By ~ 29

Author(s):

Gerold Labek ◽

Wolfgang Janda ◽

Mark Agreiter ◽

Reinhard Schuh ◽

Nikolaus Böhler

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Revision Rate ◽

Data Evaluation ◽

Arthroplasty Register ◽

Total Hip

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The risk of revision after total hip arthroplasty in young patients depends on surgical approach, femoral head size and bearing type; an analysis of 19,682 operations in the Dutch arthroplasty register

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2765-z ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 7

Author(s):

M. F. L. Kuijpers ◽

G. Hannink ◽

S. B. W. Vehmeijer ◽

L. N. van Steenbergen ◽

B. W. Schreurs

Keyword(s):

Femoral Head ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Surgical Approach ◽

Young Patients ◽

Head Size ◽

Femoral Head Size ◽

Arthroplasty Register ◽

Total Hip

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Ceramic bearings for total hip arthroplasty are associated with a reduced risk of revision for infection

Hip International ◽

10.1177/1120700018776464 ◽

2018 ◽

Vol 28 (3) ◽

pp. 222-226 ◽

Cited By ~ 8

Author(s):

Rami Madanat ◽

Inari Laaksonen ◽

Stephen E Graves ◽

Michelle Lorimer ◽

Orhun Muratoglu ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Lower Risk ◽

Revision Rate ◽

Joint Infection ◽

Bearing Surface ◽

Related Factors ◽

Total Hip ◽

Reduced Risk ◽

Ceramic On Ceramic

Introduction: Periprosthetic joint infection (PJI) is a serious complication after total hip arthroplasty (THA) and bearing material’s associations to PJI prevalence is largely unknown. The main purposes of this study were to determine if revision for infection varied depending on the type of bearing surface used in primary THA and to study whether patient or implant related factors had an effect on this variation. Methods: A total of 177,237 primary THA procedures from the Australian Registry (AOANJRR) were analysed. 3 bearing surfaces were compared. Metal-on-highly cross-linked polyethylene (MoXP) bearing had been used in 95,129 hips, ceramic-on-highly cross-linked polyethylene (CoXP) in 24,269 hips, and ceramic-on-ceramic (CoC) in 57,839 hips. Revision rates for infection were compared between the 3 groups. Results: Both MoXP and CoXP had a higher revision rate for infection compared to CoC hips (hazard ratio [HR] 1.46 (1.25, 1.72), p < 0.001) and HR 1.42 (1.15, 1.75), p = 0.001 respectively). Patients aged 70 years or less had a lower revision rate for infection when a CoC bearing was used. This difference was independent of sex, and prostheses selection. No difference was evident if the femoral component was cemented or a head size of 28 mm was used. Discussion: In this registry-based material, use of a CoC bearing was associated with a lower risk of revision for infection in patients younger than 70 years when cementless femoral components were used. Further studies are needed to verify this finding.

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32-mm ceramic-on-ceramic total hip arthroplasty versus 28-mm ceramic bearings: 5- to 15-year follow-up study

Hip International ◽

10.1177/1120700018760971 ◽

2018 ◽

Vol 29 (1) ◽

pp. 65-71 ◽

Cited By ~ 3

Author(s):

Yoshitoshi Higuchi ◽

Taisuke Seki ◽

Yukiharu Hasegawa ◽

Yasuhiko Takegami ◽

Daigo Morita ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Harris Hip Score ◽

Total Hip ◽

Kaplan Meier ◽

Significant Difference ◽

Average Patient ◽

The Mean ◽

Ceramic On Ceramic

Introduction: This study aimed to compare the clinical and radiographic results of 28-mm ceramic-on-ceramic (CoC) total hip arthroplasty (THA) to those of 32-mm CoC during a 5- to 15-year follow-up period. Methods: 107 joints (95 women and 6 men) underwent 28-mm CoC, and 60 (49 women and 7 men) underwent 32-mm CoC. The average patient age at the time of surgery was 56.1 and 55.7 years in the 28-mm and 32-mm CoC groups, respectively. Clinical and radiologic measurements of all patients were analysed. Results: The mean preoperative Harris hip score (HHS) was similar in the 2 groups (28-mm, 58.9; and 32-mm, 58.5). However, at final follow-up, the mean HHS of the 32-mm CoC (91.8) was significantly better than that of the 28-mm CoC (88.2) ( p = 0.003), as were the ranges of motion (ROM) for flexion (98.3 ± 13.5° vs. 87.3 ± 19.3°, p < 0.001) and abduction (27.8 ± 14.9° vs. 22.1 ± 19.3°, p = 0.007). The mean wear rate was 0.0044 mm/year for the 28-mm CoC and 0.0044 mm/year for the 32-mm CoC. No ceramic fractures were found in the 2 groups. One joint in the 28-mm CoC (0.9%) required revision owing to progressive osteolysis. Kaplan-Meier survival at 10 years, with implant loosening or revision THA as the endpoint, was 98.3% for 28-mm CoC and 100% for 32-mm CoC ( p = 0.465). Conclusion: There was no significant difference in ceramic-related complications between the 2 groups. Our study demonstrated that the 32-mm and 28-mm CoC are safe and are associated with good clinical outcomes.

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